What is the financial burden to patients of accessing surgical care in Sierra Leone? A cross-sectional survey of catastrophic and impoverishing expenditure.
BMJ Open
; 11(3): e039049, 2021 03 08.
Article
en En
| MEDLINE
| ID: mdl-34006018
ABSTRACT
OBJECTIVES:
To measure the financial burden associated with accessing surgical care in Sierra Leone.DESIGN:
A cross-sectional survey conducted with patients at the time of discharge from tertiary-level care. This captured demographics, yearly household expenditure, direct medical, direct non-medical and indirect costs for surgical care, and summary household assets. Missing data were imputed.SETTING:
The main tertiary-level hospital in Freetown, Sierra Leone.PARTICIPANTS:
335 surgical patients under the care of the hospital surgical team receiving operative or non-operative surgical care on the surgical wards. OUTCOMEMEASURES:
Rates of catastrophic expenditure (a cost >10% of annual expenditure), impoverishment (being pushed into, or further into, poverty as a result of surgical care costs), amount of out-of-pocket (OOP) costs and means used to meet these costs were derived.RESULTS:
Of 335 patients interviewed, 39% were female and 80% were urban dwellers. Median yearly household expenditure was US$3569. Mean OOP costs were US$243, of which a mean of US$24 (10%) was spent prehospital. Of costs incurred during the hospital admission, direct medical costs were US$138 (63%) and US$34 (16%) were direct non-medical costs. US$46 (21%) were indirect costs. Catastrophic expenditure affected 18% of those interviewed. Concerning impoverishment, 45% of patients were already below the national poverty line prior to admission, and 9% of those who were not were pushed below the poverty line following payment for surgical care. 84% of patients used household savings to meet OOP costs. Only 2% (six patients) had health insurance.CONCLUSION:
Obtaining surgical care has substantial economic impacts on households that pushes them into poverty or further into poverty. The much-needed scaling up of surgical care needs to be accompanied by financial risk protection.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
1_ASSA2030
/
2_ODS3
Problema de salud:
1_financiamento_saude
/
2_cobertura_universal
Asunto principal:
Pobreza
/
Gastos en Salud
Tipo de estudio:
Health_economic_evaluation
/
Observational_studies
/
Prevalence_studies
/
Risk_factors_studies
Aspecto:
Determinantes_sociais_saude
Límite:
Female
/
Humans
/
Male
País/Región como asunto:
Africa
Idioma:
En
Revista:
BMJ Open
Año:
2021
Tipo del documento:
Article
País de afiliación:
Reino Unido